E-SHAP: Inadequate treatment for poor-prognosis recurrent lymphoma

Background: The treatment of refractory and recurrent lymphomas remains problematic, with the majority of patients showing no response to 'salvage' therapies. One regimen which has been suggested as showing particular efficacy is etoposide (40 mg/m² daily × 4), cytosine arabinoside (2.0 g/m² one dose), cisplatin (25 mg/m²/day infused over 4 days) and methylprednisolone (500 mg daily × 4) (E-SHAP). This study attempted to reproduce the encouraging results seen with this regimen in North America.Patients and methods: Twenty-eight patients with recurrent or refractory lymphoma were treated with E-SHAP given 3 to 4 weekly. Thirteen patients were treated at first recurrence and twenty-two had previously received etoposide.Results: No objective responses were seen although five patients had a transient reduction in tumour before regrowth despite continued treatment. Sixteen patients received further chemotherapy after failure of E-SHAP of whom four had responses. The principal toxicity was myelosuppression with over half the patients requiring hospital admission for neutropenia-associated fever. Median time to treatment failure was 2.5 months and median survival 7 months from the start of E-SHAP.Conclusions: These results are in marked contrast to those reported from North America, possibly due to differing patient selection. E-SHAP shows strictly limited efficacy but marked toxicity in the treatment of recurrent or refractory lymphomas with poor prognostic features.